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EARLY OUTCOME OF SUCCESSIVE CAROTID ARTERY STENTING FOLLOWED BY CORONARY ARTERY BYPASS GRAFTING
303 JACC April 5, 2016 Volume 67, Issue 13
ACC.i2 Interventional Cardiology EARLY OUTCOME OF SUCCESSIVE CAROTID ARTERY STENTING FOLLOWED BY CORONARY ARTERY BYPASS GRAFTING Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: ACC.i2 Interventional Cardiology: Carotid and Endovascular Intervention Abstract Category: 4. ACC.i2 Interventional Cardiology: Carotid and Endovascular Intervention Presentation Number: 1223-138 Authors: Sherif Medhat Sabri, Cairo University Hospital, Cairo, Egypt
Background: Management of patients with concomitant carotid & coronary artery disease requiring cardiac surgery presents a challenge. Avoidance of stroke(CVS), MI(myocardial infarction),and death within 30 days is important.The aim of this work is to evaluate same-day carotid artery stenting (CAS) & coronary artery bypass grafting(CABG).
Methods: Thirty consecutive patients with severe carotid & coronary artery disease underwent same-day CAS & urgent CABG. Procedures were performed at a single center.Patients underwent CAS under embolic protection devices & then CABG on the same day. Tirofiban infusion was started one hour before CAS & was maintained for 4 hours, then discontinued 2 hours before CABG. The primary end point of the study was the composite incidence rate of MI, CVS, and death within 30 days. Patients underwent offpump CABG, except 1 for valve surgery. Clopidogrel and aspirin was initiated once postoperative bleeding was not suspected.
Results: There were 23 males & 7 females, mean age was 66,93 years. There were 17 diabetic patients (56.7%), and 13 patients were hypertensive (43.3%). All patients had good left ventricular function before surgery. Peripheral vascular disease was present in 6 patients(20.0%).Five patients had left main disease (16.7%),14 patients had triple vessel disease (46.7%), and 14 patients had proximal LAD disease (46.7%). One patient had concomitant aortic valve replacement with CABG. Twenty patients had right CAS with a mean stenosis of 80% & a mean of 38% stenosis in the contralateral side. Ten patients had left CAS with mean stenosis of 83% & a mean of 37% in the contralateral side (statistically insignificant).No major or minor CVS or MI during the follow up. A single patient had drop of blood pressure(BP) following CAS prior to CABG ;this patient had CABG after stabilization of the BP, within 4 hours of CAS with no complications. One patient had postoperative bleeding following CABG, managed with blood & plasma transfusion. The non-survived patient had a right CAS prior to aortic valve replacement and CABG; died during 2nd day due to intractable arrhythmia . Conclusions: Same-day approach appeared safe with low in-hospital mortality for consecutive CAS/CABG .
ACC.i2 Interventional Cardiology EARLY OUTCOME OF SUCCESSIVE CAROTID ARTERY STENTING FOLLOWED BY CORONARY ARTERY BYPASS GRAFTING Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: ACC.i2 Interventional Cardiology: Carotid and Endovascular Intervention Abstract Category: 4. ACC.i2 Interventional Cardiology: Carotid and Endovascular Intervention Presentation Number: 1223-138 Authors: Sherif Medhat Sabri, Cairo University Hospital, Cairo, Egypt
Background: Management of patients with concomitant carotid & coronary artery disease requiring cardiac surgery presents a challenge. Avoidance of stroke(CVS), MI(myocardial infarction),and death within 30 days is important.The aim of this work is to evaluate same-day carotid artery stenting (CAS) & coronary artery bypass grafting(CABG).
Methods: Thirty consecutive patients with severe carotid & coronary artery disease underwent same-day CAS & urgent CABG. Procedures were performed at a single center.Patients underwent CAS under embolic protection devices & then CABG on the same day. Tirofiban infusion was started one hour before CAS & was maintained for 4 hours, then discontinued 2 hours before CABG. The primary end point of the study was the composite incidence rate of MI, CVS, and death within 30 days. Patients underwent offpump CABG, except 1 for valve surgery. Clopidogrel and aspirin was initiated once postoperative bleeding was not suspected.
Results: There were 23 males & 7 females, mean age was 66,93 years. There were 17 diabetic patients (56.7%), and 13 patients were hypertensive (43.3%). All patients had good left ventricular function before surgery. Peripheral vascular disease was present in 6 patients(20.0%).Five patients had left main disease (16.7%),14 patients had triple vessel disease (46.7%), and 14 patients had proximal LAD disease (46.7%). One patient had concomitant aortic valve replacement with CABG. Twenty patients had right CAS with a mean stenosis of 80% & a mean of 38% stenosis in the contralateral side. Ten patients had left CAS with mean stenosis of 83% & a mean of 37% in the contralateral side (statistically insignificant).No major or minor CVS or MI during the follow up. A single patient had drop of blood pressure(BP) following CAS prior to CABG ;this patient had CABG after stabilization of the BP, within 4 hours of CAS with no complications. One patient had postoperative bleeding following CABG, managed with blood & plasma transfusion. The non-survived patient had a right CAS prior to aortic valve replacement and CABG; died during 2nd day due to intractable arrhythmia . Conclusions: Same-day approach appeared safe with low in-hospital mortality for consecutive CAS/CABG .